Quality management of medical specialist care in the Netherlands : an explorative study of its nature and development

In January 1985, the author of this study was employed as a scientific staff member at CBO, the Dutch National Organisation for Quality Assurance in Hospitals. His main job was to support peer review committees of medical specialists in hospitals. The task proved to be challenging and was broadened to an active involvement in the consensus development programme run by CBO'S scientific council. Both peer review and guideline development through consensus conferences turned out to be far more complex activities than might be expected at first sight. Hence over the years the ambition emerged to study these phenomena more thoroughly. From the beginning it was clear that peer review and guideline development are only two of the various systematic activities the medical profession has developed to manage the quality of specialist care. This study is rooted in the curiosity to understand these activities and in its essence the study tries to provide an answer to two questions: • What is quality management of medical specialist care? • How does it develop

Shelter-based convalescence for homeless adults in Amsterdam: a descriptive study

<p>Abstract</p> <p>Background</p> <p>Adequate support for homeless populations includes shelter and care to recuperate from illness and/or injury. This is a descriptive analysis of diagnoses and use of shelter-based convalescence in a cohort of homeless adults in Amsterdam.</p> <p>Methods</p> <p>Demographics of ill homeless adults, diagnoses, referral pattern, length of stay, discharge locations, and mortality, were collected by treating physicians during outreach care provision in a shelter-based convalescence care facility in Amsterdam, from January 2001 through October 2007.</p> <p>Results</p> <p>629 individuals accounted for 889 admissions to the convalescence care facility. 83% were male and 53% were born in the Netherlands. The mean age was 45 years (SD 10 years). The primary physical problems were skin disorders (37%), respiratory disorders (33%), digestive disorders (24%) and musculoskeletal disorders (21%). Common chronic conditions included addictions 78%, mental health disorders 20%, HIV/AIDS 11% and liver cirrhosis 5%. Referral sources were self-referred (18%), general hospitals (21%) and drug clinics (27%). The median length of stay was 20 days. After (self)discharge, 63% went back to the previous circumstances, 10% obtained housing, and 23% went to a medical or nursing setting. By March 2008, one in seven users (n = 83; 13%) were known to have died, the Standard Mortality Ratio was 7.5 (95% CI: 4.1-13.5). Over the years, fewer men were admitted, with significantly more self neglect, personality disorders and cocaine use. Lengths of stay increased significantly during the study period.</p> <p>Conclusion</p> <p>Over the last years, the shelter-based convalescence care facility users were mainly homeless single males, around 45 years of age, with chronic problems due to substance use, mental health disorders and a frail physical condition, many of whom died a premature death. The facility has been flexible and responsive to the needs of the users and services available.</p

OECD’s work on health care quality and outcomes indicators: Implications for the Croatian healthcare system in the light of the ongoing accession process

Aktualni proces pristupanja Hrvatske Organizaciji za ekonomsku suradnju i razvoj (OECD) jedinstvena je prilika za opis djelovanja ove međunarodne organizacije u području zdravstva te pregled predviđenih implikacija za hrvatski zdravstveni sustav. Pregled se posebno osvrće na rad OECD-a u području pokazatelja kvalitete, sigurnosti i ishoda zdravstvene zaštite te je zasnovan na znanstvenoj i sivoj literaturi kao i višegodišnjem iskustvu autora u radu s OECD-om. OECD je prepoznat po svojim naporima u prikupljanju i analizi podataka i izvještavanju o zdravstvenoj kvaliteti, sigurnosti i ishodima na globalnoj razini. Rad OECD-a u području zdravstva uključuje komparativnu analiza podataka, procjenu kvalitete zdravstvene skrbi u zemljama članicama, mjerenje ishoda zdravstvene skrbi te analizu učinkovitosti i pravednosti zdravstvenih sustava. Implikacije za hrvatski zdravstveni sustav u svjetlu pristupnog procesa mnogostruke su i odnose se na zdravstveni sustav, ustanove, zdravstvene djelatnike kao i pacijente. U ovom procesu prije, ali i nakon pristupa OECD-u, pridržavajući se međunarodnih standarda, učeći iz najboljih praksi i poboljšavajući podatkovnu kulturu, Hrvatska može raditi na postizanju bolje kvalitete zdravstvene skrbi, poboljšanih zdravstvenih ishoda i učinkovitijeg zdravstvenog sustava. U ovom je procesu važno da se kreatori politike (engl. policy-makers) i dionici u Hrvatskoj pozabave izazovima koji se mogu pojaviti tijekom ovog procesa kako bi se osigurala uspješna tranzicija u članstvo u OECD-u i povezane koristi za zdravstveni sektor.The current process of Croatia’s accession to the Organization for Economic Co-operation and Development (OECD) is a unique opportunity to describe the activities of this international organization in the field of healthcare and review the expected implications for the Croatian healthcare system. The review focuses in particular on the work of the OECD in the field of indicators of quality, safety and health care outcomes and is based on scientific and grey literature as well as the author’s many years of experience in working with the OECD. The OECD is recognized for its efforts in collecting, analyzing and reporting data on health quality, safety and outcomes globally. The OECD’s work in the field of health includes comparative data analysis, assessment of the quality of health care in member countries, measurement of health care outcomes, and analysis of the efficiency and equity of health systems. The implications for the Croatian healthcare system in the light of the accession process are manifold and relate to the healthcare system, institutions, medical staff as well as patients. In this process, before and after accession to the OECD, by adhering to international standards, learning from best practices and improving data culture, Croatia can work towards achieving better quality of health care, improved health outcomes and a more efficient health system. In this process, it is important that policy-makers and stakeholders in Croatia address the challenges that may arise during this process in order to ensure a successful transition to OECD membership and related benefits for the health sector

Flying with doctors: Experiences with the application of 6 techniques from aviation industry in the Rotterdam Eye Hospital

Intoduction. Aviation industry is often put forward as an example in creating safer health care. Comparing aviation and health care, there are similarities in using technology, working with highly specialized professional teams and the need for dealing with risk and uncertainties (Sexton 2000; Powell 2006; Kao & Thomas 2008). Rhetorical use of the resemblance however, does not directly contribute to the safety of the health care system. To measure the added value of the experiences in aviation for the health care sector, it is preferable to study in detail the use of aviation based principals in daily practice

Data-Driven Collaboration between Hospitals and Other Healthcare Organisations in Europe During the COVID-19 Pandemic: An Explanatory Sequential Mixed-Methods Study among Mid-Level Hospital Managers

Introduction: Data and digital infrastructure drive collaboration and help develop integrated healthcare systems and services. COVID-19 induced changes to collaboration between healthcare organisations, which previously often happened in fragmented and competitive ways. New collaborative practices relied on data and were crucial in managing coordinated responses to the pandemic. In this study, we explored data-driven collaboration between European hospitals and other healthcare organisations in 2021 by identifying common themes, lessons learned and implications going forward. Methods: Study participants were recruited from an existing Europe-wide community of mid-level hospital managers. For data collection, we ran an online survey, conducted multi-case study interviews and organised webinars. Data were analysed using descriptive statistics, thematic analysis and cross-case synthesis. Results: Mid-level hospital managers from 18 European countries reported an increase in data exchange between healthcare organisations during the COVID-19 pandemic. Data-driven collaborative practices were goal-oriented and focused on the optimisation of hospitals’ governance functions, innovation in organisational models and improvements to data infrastructure. This was often made possible by temporarily overcoming system complexities, which would otherwise hinder collaboration and innovation. Sustainability of these developments remains a challenge. Discussion: Mid-level hospital managers form a huge potential of reacting and collaborating when needed, including rapidly setting up novel partnerships and redefining established processes. Major post-COVID unmet medical needs are linked to hospital care provision, including diagnostic and therapeutic backlogs. Tackling these will require rethinking of the position of hospitals within healthcare systems, including their role in care integration. Conclusion: Learning from COVID-19-induced developments in data-driven collaboration between hospitals and other healthcare organisations is important to address systemic barriers, sustain resilience and further build transformative capacity to help build better integrated healthcare systems

COVID-19 preparedness and perceived safety in nursing homes in Southern Portugal: A cross-sectional survey-based study in the initial phases of the Pandemic

(1) Background: Nursing homes’ preparedness in managing a public health emergency has been poor, with effects on safety culture. The objective of this study was to assess nursing homes’ COVID-19 preparedness in southern Portugal, including staff’s work experiences during the pandemic. (2) Methods: We used a COVID-19 preparedness checklist to be completed by management teams, followed by follow-up calls to nursing homes. Thereafter, a survey of staff was applied. Data analysis included descriptive statistics, exploratory factor analysis, and thematic analysis of open-end questions. (3) Results: In total, 71% (138/195) of eligible nursing homes returned the preparedness checklist. We conducted 83 follow-up calls and received 720 replies to the staff survey. On average, 25% of nursing homes did not have an adequate decision-making structure to respond to the pandemic. Outbreak capacity and training were areas for improvement among nursing homes’ contingency plans. We identified teamwork as an area of strength for safety culture, whereas compliance with procedures and nonpunitive response to mistakes need improvement. (4) Conclusions: To strengthen how nursing homes cope with upcoming phases of the COVID-19 pandemic or future public health emergencies, nursing homes’ preparedness and safety culture should be fostered and closely monitored.info:eu-repo/semantics/publishedVersio

Volume-outcome revisited: The effect of hospital and surgeon volumes on multiple outcome measures in oesophago-gastric cancer surgery.

BACKGROUND: Most studies showing a volume outcome effect in resection surgery for oesophago-gastric cancer were conducted before the centralisation of clinical services. This study evaluated the relation between hospital- and surgeon volume and different risk-adjusted outcomes after oesophago-gastric (OG) cancer surgery in England between 2011 and 2013. METHODS: In data from the National Oesophago-Gastric Cancer Audit from the UK, multivariable random-effects logistic regression models were used to quantify the effect of surgeon and hospital volume on three outcomes: 30-day and 90-day mortality and anastomotic leakage. The models included patient risk factors to adjust for differences in case-mix among hospitals and surgeons. The between-cluster heterogeneity was estimated with the median odds ratio (MOR). RESULTS: The study included patients treated at 42 hospitals and 329 surgeons. The median (interquartile range) of the annual hospital and surgeon volumes were 110 patients (82 to 137) and 13 patients (8 to 19), respectively. The overall rates for 30-day and 90-day mortality were 2.3% and 4.4% respectively, and the anastomotic leakage was 6.3%. Higher hospital volume was associated with lower 30-day mortality (OR: 0.94; 95% CI: 0.91-0.98) and lower anastomotic leakage rates (OR: 0.96; 95% CI: 0.93-0.98) but not 90-day mortality. Higher surgeon volume was only associated with lower anastomotic leakage rates (OR: 0.81; 95% CI: 0.72-0.92). Hospital volume explained a part of the between-hospital variation in 30-day mortality whereas surgeon volume explained part of the between-hospital variation in anastomotic leakage. CONCLUSIONS: In the setting of centralized O-G cancer surgery in England, we could still observe an effect of volume on short-term outcomes. However, the effect is inconsistent, depending on the type of outcome measure under consideration, and much smaller than in previous studies. Efforts to centralise O-G cancer services further should carefully address the effects of both hospital and surgeon volume on the range of outcome measures that are relevant to patients